Provider Demographics
NPI:1831468727
Name:GREGORCYK, LISA JOSEPHINE (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:JOSEPHINE
Last Name:GREGORCYK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6483
Mailing Address - Fax:682-885-3113
Practice Address - Street 1:410 LONE STAR DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-8140
Practice Address - Country:US
Practice Address - Phone:325-670-3910
Practice Address - Fax:325-670-3919
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU48102080P0202X
VA0101255004208000000X
GA0805332080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics